Studies show e-cigarettes help smokers in the EU and US quit or reduce cigarette use

Electronic cigarettes (e-cigarettes or “vapes”) are helping many smokers in the European Union and United States quit or reduce their cigarette consumption.

“More than six million smokers in the EU have quit smoking and more than 9 million have reduced smoking consumption with the use of e-cigarettes. These are probably the highest rates of smoking cessation and reduction ever observed in such a large-population study,” said Dr. Konstantinos E. Farsalinos, principal investigator of a study that analyzed data from the 2014 Eurobarometer survey on smoking and e-cigarette use patterns in all 28 member-states of the EU.

Published in 2016 in the journal Addiction, the study was conducted by scientists from the University of Patras-Greece, Onassis Cardiac Surgery Centre-Greece and the French National Research Institute for Health and Medical Research. Conducted by the European Commission, the Eurobarometer survey found that 48.5 million Europeans have ever tried e-cigarettes, but 7.5 million are current users. Among current e-cigarette users, 35% have quit smoking while an additional 32% have reduced their smoking consumption.

Dr. Farsalinos, Research Fellow at the Onassis Cardiac Surgery Center and University of Patras, said that a mere 2% of smokers who stop smoking suddenly and completely—quitting cold turkey—are able to quit for good. “At least 8 out of 10 smokers fail to quit with currently approved smoking cessation methods. At one year, less than 1 in 10 smokers who use nicotine replacement therapies [NRTs] and only 1 in 4 smokers taking oral smoking cessation medications such as varenicline are able to quit successfully.”

Dr. Farsalinos spoke during a media briefing held on April 5, 2017 at the Holiday Inn Glorietta in Makati City.

E-cigarettes help smokers in UK quit
Dr. Farsalinos cited the results of a study by Action on Smoking and Health released in 2016 showing that the number of e-cigarette users in Great Britain has been steadily increasing since 2012. The study found that the number of smokers in Great Britain is decreasing while the number of ex-smokers is increasing.

“The study also revealed that regular e-cigarette use among non-smokers in Great Britain is minimal to zero—providing more evidence that e-cigarettes are not a gateway to smoking,” Dr. Farsalinos noted.

E-cigarettes help American teen smokers quit
Dr. Farsalinos also presented results of the 2016 Monitoring the Future (MTF) survey, which showed that since e-cigarettes became popular, smoking decline has accelerated among adolescent students in the US. The survey indicated that e-cigarettes are more popular than regular tobacco cigarettes among American adolescent students.

Since 1975 the MTF survey has measured drug, alcohol, and cigarette use and related attitudes among adolescent students nationwide. Survey participants report their drug use behaviors across three time periods: lifetime, past year, and past month. Overall, 45,473 students from 372 public and private schools participated in the 2016 MTF survey. The survey is funded by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health (NIH), and conducted by the University of Michigan.

Nicotine doesn’t kill, tar does
According to Dr. Farsalinos, tobacco cigarettes are a very effective and the most harmful nicotine delivery system ever developed. Nicotine is the drug in tobacco that causes addiction to smoking. Its stimulant effect adds to the addictive properties of tobacco smoking.

Nicotine is a highly addictive drug that acts in the brain and throughout the body. When inhaled, it travels quickly to the brain and can cause a feeling of temporary relaxation and/or stress relief. Nicotine can also elevate the smoker’s mood and heart rate. However, while smoking is a leading cause of heart disease, stroke, and lung cancer, among many others, these diseases are not caused by nicotine. Dr. Farsalinos quoted Professor Michael Russell, a pioneer in the study of tobacco dependence, who in 1976 said, “People smoke for nicotine but die from the tar.”

Tar refers to the combustion products of cigarettes produced by the burning of organic matter, dried tobacco leaf, Dr. Farsalinos explained. These combustion products are burned at a temperature of over 800ºC, which produces many toxins (carbon monoxide, formaldehyde, ammonia, hydrogen cyanide, arsenic, DDT, etc.) that are subsequently inhaled by the smoker.

Aside from the biochemical “hook” of nicotine, the behavioral aspects of smoking compound tobacco addiction, Dr. Farsalinos said. “These refer to the rituals and sensory stimulation of smoking—the hand to mouth movement, seeing visible smoke coming out of your mouth and nose, holding the cigarette in your hand.”

E-cigarettes: effective tobacco harm reduction and quit smoking approach
Dr. Farsalinos said there are many studies showing that e-cigarettes by far carry a lower risk than tobacco cigarettes. Two of the most recent and most authoritative are those of Public Health England released in 2015 and the Royal College of Physicians released in 2016. The independent studies both concluded that e-cigarettes are at least 95 percent less harmful than smoking.

“E-cigarettes are a lot safer than tobacco cigarettes because e-cigarettes heat and vaporize liquid at lower temperatures reaching only 180ºC to 250ºC. Unlike tobacco cigarettes, e-cigarettes do not burn organic matter at very high temperatures and therefore do not produce toxic fumes,” Dr. Farsalinos explained.

The main components of the liquid used in e-cigarettes (“e-liquid”) are propylene glycol and glycerin, accounting for 95% of the e-liquid. The remaining components are water, nicotine, and food-grade flavorings. “There is no single component of e-liquid that was developed particularly for e-cigarettes. Glycerin was approved for human consumption in 1959, propylene glycol in 1982,” said Dr. Farsalinos.

According to Dr. Farsalinos, e-cigarettes are effective in helping smokers quit because they address the biochemical and behavioral aspects of smoking addiction. E-cigarettes mimic the sensation of smoking and deliver nicotine to users in the form of a vapor—thus the term “vaping”—without the harmful chemicals present in tobacco products. E-cigarettes provide the oral fixation as well as the experience of inhaling, feeling the smoke hit the back of the throat (“throat hit”), and seeing the vapor cloud when exhaling.